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norma—rnwronmental Pfateclian Agency <br /> 'Form Approved OMB No.2050-0039(Expires 9-30-99 <br /> Plea se prim or type Fortis designed far use on elite(I2 ewrile See InstrttctionS on ba ���g <br /> �p Department of Toxic Substances Cant, <br /> UNIFORM HAZARDO�$ ^ ice -- Sacramento,California <br /> 1• Generator's US EPA ID No. <br /> Manifest Do[umenl No. 2. Page 1 Information in the shaded Areas <br /> WASTE MANIFEST �' ]] 7 is not required by Federal law. <br /> 3. Generator's Name and Meiling Address of ] <br /> INTERSTATE %'i UCK c&�T f ER A. state Manifest Document Number <br /> ..�a_ BOX C 23374843 <br /> 9"1'C3CIn:'�r'7 CA 9S�D6 <br /> 4. Generator's Pone (800 I B, State Generator's ID <br /> r` :�"'�?1•-�155� <br /> CN 5. Transporter 1 Company Name <br /> ao 6. US EPA 1D Number C. State Transporler's ID(Reservad.] <br /> Q BHO'-? HA-A DS 4OLUTION3 <br /> F1 0 n f5 6 $ ] D. Transporter"s Phone <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number <br /> E. State Tronsporter's ID(Reser ed. <br /> C)U 9. Designated Facility Name and 51e Address F. Transporter's Phone i <br /> lE () Etr10. US EPA ID Number <br /> G. State Facility's ID <br /> 1620 U 17TH 87' <br /> LONG BEACH, CA 9081;3 H. Facillly's Phone <br /> t^� Q f t <br /> 1 U 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) ry� <br /> �R 12. Containers 13. Tot°I 14. Unit <br /> No, Type Quantity "Y 1 I. Waste Number <br /> 3 L e rpau i , t r (e.�lrh not �exceedingf Stale <br /> �i G Y• x 2_.i,., LTtti:i.i50, (x3003.) :31 <br /> E <br /> b. 0 0 1 D M EPA/011ier <br /> i7 a Q <br /> 00 E SAWDUST OIL P <br /> to <br /> N R P1031--nCRA HAZARrious w,&sTE: 90LID Stale <br /> A EPA/other <br /> o r,� c. 0 0 3. [? M 0 0 '� �a 0 nen—ren,� <br /> SO O <br /> ' Ssare <br /> d. EP /Other <br /> Z <br /> w <br /> U Stare <br /> u, <br /> Z J. Additlano)Descriptions f 1t�6j�fia s LJ'�lad Abp a EPA/Other <br /> ) rsrrr<" � 39 'FC3E'TLEf27di5Jf K. Handling Codes for Wastes Listed Above <br /> V) Y <br /> a• b. <br /> 4 <br /> Z C. d <br /> 0 15. Special Handling Instructions and Additional Information <br /> Q APPROPRIATE PRO41ECTCIVE CLOTHING p+"� <br /> Z JOB SITE: 825 tlA' Y , �rlsst1C'd'I�1V, r_ r{p <br /> "EMERGENCY CONTACT: (800) 7'46-7499" �A 0--52o(i <br /> :%EE E.A_G_ PAGE # 3-26 <br /> = J <br /> H <br /> - 16. GENERATOR'S CEed,and are <br /> i I hereby declare that the contents of this can sig menl ore Fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labored,and are in all respects in proper condition for transport by highway according t°applicable international and naiionnl government regulations. <br /> or or— If!am a quant!ty generoror,I certify that I have a prog�om in alace to reduce the volume and toxicity of waste generated to the degree I have determined to be economic y <br /> practbe bj.an and that I have selected m practicable method of(have nt,storage,or disposal currently Available to me which minimizes the present and future threat b human is 11 <br /> and the Jorgeeto me meat;OR, if I am a small quantity generator,1 have made a goad faith efsal to minimize m w m call <br /> O avml°bre to me and that I can afford. y aste generation and select the best waste management melhod that is <br /> � ' Printed/T ped Name <br /> 5lgnalure <br /> It 'd /�7� Month Day Year <br /> 0 T 17. Trans atter 1 Acknawled oment of Recei t of Moleriols f y r <br /> w NR " z e) <br /> Printed ed Nome - <br /> Signalu _ <br /> w P Monikl Day Year <br /> 0 R 18. Trans orter 2 Acknowled ement of Recei t of Materials RJ -'`]/ '. <br /> a B Printed/Typed Name <br /> rr j E Sgnaivae <br /> R Month Day Year <br /> U F 19. Discrepancy Indication Space <br /> z _.— <br /> A <br /> C <br /> L <br /> I Faeili Owner or O orator CerriBcolion of racei t of hazardous materials covered L.-thi <br /> Pri s manifest exce f as Holed in Item 14. <br /> T Printed/Typed Name <br /> Signatwe <br /> Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. --- <br /> DISC 8022A (1/$9) <br /> EPA 8700--22 Blue; GENERATOR SENDS THIS COPY TO pTSC <br /> To: P.O. Box 400, Sacramento, CA 95812-0,100 30 DAYS, <br />